Healthcare Provider Details

I. General information

NPI: 1407008931
Provider Name (Legal Business Name): CENTER FOR ORAL & MAXILLOFACIAL SURGERY & DENTAL IMPLANTOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SCHOOL RD E SUITE #1
MARLBORO NJ
07746-2062
US

IV. Provider business mailing address

15 SCHOOL RD E SUITE #1
MARLBORO NJ
07746-2062
US

V. Phone/Fax

Practice location:
  • Phone: 732-625-2244
  • Fax: 732-625-1244
Mailing address:
  • Phone: 732-625-2244
  • Fax: 732-625-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number22DI02185300
License Number StateNJ

VIII. Authorized Official

Name: DR. EDWARD KOZLOVSKY
Title or Position: OWNER
Credential: D.M.D.
Phone: 732-625-2244